Ultrasound evaluation of infrapatellar fat pad impingement: An exploratory prospective study

Mikkilineni, Himabindu; Delzell, Patricia B.; Andrish, Jack T.; Bullen, Jennifer; Obuchowski, Nancy A.; Subhas, Naveen; Polster, Joshua M.; Schils, Jean

doi:10.1016/j.knee.2018.01.008

Cited by 13 publications

(10 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These data match the changes in the antero‐posterior distance of the largest US fat lobule measured at 0° and 90° by US, described by Mikkilineni et al. () as a value which determines the percentual compressibility of the lobule itself. Changes in superficial US adipose lobules may also reflect differences in the radius of the curvature between the superficial and deep locations of the IFP in the flexed knee.…”

Section: Discussionsupporting

confidence: 86%

“…US enables dynamic and comparative assessment in real time (Naredo, ) and some US parameters show significant differences in cases of IFP impingement (Mikkilineni et al. ). More detailed knowledge of the dynamic (flexo‐extension movements) US characteristics of the IFP in asymptomatic subjects with respect to histological data may be very useful, allowing better understanding of pathological findings.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The characteristics of the lobular arrangement indicate the dynamic role played by the infrapatellar fat pad in knee kinematics

et al. 2019

View full text Add to dashboard Cite

The infrapatellar fat pad (IFP) is an intracapsular but extrasynovial structure, located between the patellar tendon, the femoral condyles and the tibial plateau. It consists of white adipose tissue, organised in lobules defined by thin connective septa. The aim of this study is the morphometric and ultrasonographic analysis of IFP in subjects without knee pathology during flexion-extension movements. The morphometric study was conducted on 20 cadavers (15M, 5F, mean age 80.2 years). Ultrasound was performed on 24 volunteers with no history of knee diseases (5M, 19F, mean age: 45 years). The characteristics of the adipose lobules near the patellar tendon and in the deep portion of the IFP were evaluated. Numerical models were provided, according to the size of the lobules. At histological examination, the adipose lobules located near the patellar tendon were larger (mean area 12.2 mm 2 AE 5.3) than those at a deeper level (mean area 1.34 mm 2 AE 0.7, P < 0.001) and the thickness of the septa of the deepest adipose lobules (mean value 0.35 mm AE 0.32) was greater than that of the superficial one (mean value 0.29 mm AE 0.25, P < 0.001). At ultrasound, the IFP was seen to be composed of very large lobules in the superficial part (mean area 0.29 cm 2 AE 0.17 in extension), with a significant reduction in flexion (mean area 0.12 cm 2 AE 0.07, P < 0.01). The deep lobules were smaller (mean area 0.11 cm 2 AE 0.08 in extension) and did not change their values (mean area 0.19 cm 2 AE 0.52 in flexion, P > 0.05). In the sagittal plane, the reduction of thickness of the superficial layer (with large adipose lobules) during flexion was 20.6%, whereas that of the deep layer (with small adipose lobules) was 1.3%. Numerical simulation of vertical loads, corresponding to flexion of the knee, showed that stress mainly developed within the interlobular septa and opposed bulging of the lobules. The characteristics of the lobular arrangement of the IFP (large lobules with superficial septa in the superficial part and small lobules with thick septa in the deep one), significant changes in the areas and perimeters of the superficial lobules, and the reduced thickness of the superficial layer during flexion all indicate the dynamic role played by the IFP in knee kinematics.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

The characteristics of the lobular arrangement indicate the dynamic role played by the infrapatellar fat pad in knee kinematics

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Draghi et al [21] reported that MRI is the modality of choice in the assessment of pathological changes of the Hoffa's fat pad. Mikkilineni et al [36] prospectively emphasized that ultrasonography may be valuable for the diagnosis of impingement of the Hoffa's fat pad, which needs more research. In this study, the sensitivity and specificity of ultrasonography were 66.7% and 100%, respectively for diagnosing impingement of the Hoffa's fat pad.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of ultrasonography in the assessment of anterior knee pain

et al. 2020

View full text Add to dashboard Cite

Background Anterior knee pain (AKP) is a problematic complaint, considered to be the most frequent cause of orthopedic consultancy for knee problems. This study aimed to highlight diagnostic accuracy of ultrasonography as a fast imaging technique in assessment of patients with AKP. Methods and results A prospective study was conducted on 143 patients with clinically confirmed AKP. All patients underwent ultrasonography and MRI examinations of the knee. The diagnostic accuracy of ultrasonography compared to MRI for evaluating different findings of possible causes of AKP were analyzed using receiver operating characteristic (ROC) curve and judged by area under curve (AUC). A total of 155 knees were included in the study; 26 knees showed no abnormalities, 19 knees showed positive MRI only, and 110 knees showed positive ultrasonography and MRI. Ultrasonography and MRI reported 11 different findings of possible causes of AKP or related to it. Joint effusion was the most common finding (38%) followed by trochlear cartilage defect (20.6%) and superficial infrapatellar subcutaneous edema (20%). The overall accuracy of ultrasonography was 85.3% sensitivity and 100% specificity. The ultrasonography provided the highest sensitivity (100%) in detecting bipartite patella, followed by 91.5% for joint effusion, and 87.5% for quadriceps tendinopathy. The ROC curve analysis of overall accuracy of ultrasonography showed an AUC of 0.93. The overall Kappa agreement between ultrasonography and MRI was good (k = 0.66). Conclusion Ultrasonography can be used to make a swift screening and assessment of painful anterior knee and as an alternative to MRI when it is unavailable or contraindicated.

show abstract

“…Protocols of 86 MRI examinations of knee joints with anterior knee pain syndrome and no clearly defined traumatic history nor ТРАВМАТОЛОГИЯ И ОРТОПЕДИЯ РОССИИ / TRAUMATOLOGy AND ORTHOPEDICS OF RUSSIA 2019;25(2) введение жировое тело Гоффа -интракапсулярная экстрасиновиальная структура, увеличивающая площадь синовиальной поверхности и влияющая на распределение внутрисуставной жидкости [1][2][3]. Оно ограничено со всех сторон: спереди -собственной связкой надколенника, кверху и кпереди -нижней поверхностью надколенника, кверху и кзадихрящом блока бедренной кости, кзади -передней крестообразной связкой и синовиальной оболочкой, книзу -большеберцовой костью и передними рогами менисков, упираясь в глубокую инфрапателлярную сумку [4,5].…”

Section: Introductionunclassified

Magnetic Resonance Imaging of Hoffa’s Fat Pad

Stulov

Тарасов

2019

Traumatology and Orthopedics of Russia

View full text Add to dashboard Cite

Background. Pathological changes in the size and structure of Hoffa’s fat pad can cause pain in the anterior section of the knee joint. Therefore, they should be diagnosed. The objective of the paper is to improve the diagnostics of Hoffa’s fat pad disease on the basis of a detailed study of the clinical anatomy of the infrapatellar (Hoffa’s) fat pad and magnetic resonance imaging (MRI) findings in normal and pathological conditions.Materials and Methods. Protocols of 86 MRI examinations of knee joints with anterior knee pain syndrome and no clearly defined traumatic history nor positive clinical tests indicating damage to the intra-articular and periarticular elements with identified structural changes in the fat pad were selected retrospectively. The control group consisted of data from 24 examinations of asymptomatic knee joints. In all cases, the pathology was confirmed during diagnostic and therapeutic arthroscopy.Results. The MRI findings showed the normal structure of the infrapatellar fat pad, as well as pathological changes in the form of tearing, local edema, diffuse edema, synovial proliferation and fibrosis. Depending on the location and type of changes, 4 pathological syndromes were identified: “classic” Hoffa’s disease — 49 (57%) cases, infrapatellar synovial fold syndrome — 11 (13%), infrapatellar synovial fold separation syndrome — 6 (7%), and impingent syndrome of upper lateral adipose tissue — 20 (23%) cases.Conclusions. To identify a pathology, a precise synchronization of clinical and morphological changes is required. Accurate differentiation of syndromes is possible due to knowledge of the detailed anatomical and magnetic-resonance features of the fat pad in normal and pathological conditions. This allows to diagnose the cause of pain in the anterior sections of the knee joint, specify the diagnosis, and choose the optimal plan of treatment.

show abstract

Ultrasound evaluation of infrapatellar fat pad impingement: An exploratory prospective study

Cited by 13 publications

References 14 publications

The characteristics of the lobular arrangement indicate the dynamic role played by the infrapatellar fat pad in knee kinematics

The characteristics of the lobular arrangement indicate the dynamic role played by the infrapatellar fat pad in knee kinematics

Diagnostic accuracy of ultrasonography in the assessment of anterior knee pain

Magnetic Resonance Imaging of Hoffa’s Fat Pad

Contact Info

Product

Resources

About